Costa_2026_Regul.Toxicol.Pharmacol_173_106270

The intensive use of pesticides, as in coffee production, is associated with increased health risks among rural workers. Exposure and effect biomarkers are commonly used to assess occupational exposure and potential biological effects of these chemicals. However, global frameworks for occupational risk management remain incomplete, as regulatory agencies typically recommend monitoring cholinesterase activity as a biomarker, despite many pesticides not sharing this mechanism of action. Moreover, occupational exposure often involves complex mixtures of pesticides that are not adequately captured by cholinesterase-based monitoring alone. This study presents a critical and elucidative review highlighting the potential applicability of alternative biomarkers beyond cholinesterase inhibition. Only analytical human studies involving rural workers (n = 17), published in or after 2019 and employing biomarkers of exposure and/or effect, were included, in accordance with PRISMA statement guidelines. The review identified several potential biomarkers for monitoring pesticide exposure and highlighted the frequent use of genotoxicity assays and oxidative stress markers as effect biomarkers, which were suggestively associated with urinary levels of pesticide metabolites used as exposure biomarkers. These findings support occupational health practices, acknowledge the limitations of predominantly cross-sectional designs, encourage further research, and inform the development of more effective regulatory frameworks, contributing to improved quality of life of workers.